What to know about melanoma diagnosis

Self-examination

The American Cancer Society (ACS) suggests that people should try to become familiar with their skin. This may make them more aware of any new or changing moles, freckles, or blemishes.

Skin changes to look out for include:

• new, growing, or changing spots or bumps
• bleeding sores
• sores that do not heal for several weeks
• scaly or rough inflamed patches of skin that may bleed or develop a crust
• growths that look similar to warts
• moles that have changed color, size, or shape
• oddly shaped moles
• moles with irregular borders or different colored patches

One way to do this is through a skin self-examination.

Learn more about how to identify melanoma symptoms.

How to perform a self-examination

The ACS indicates that it may be best to do this after a shower or bath, in front of a well-lit mirror, and with the help of family, partners, or friends for areas that are more difficult to see, such as the scalp or back.

Doctors may recommend that people do this once a month, especially if they have a higher risk of melanoma.

The steps are as follows:

1. While facing the mirror, people should check the skin of their face, neck, ears, chest, and abdomen. A person should lift any folds of skin to observe the skin underneath, if necessary.
2. Still facing the mirror, they should then check under the arms, both sides of both arms, the palms, the backs of the hands, and under the fingernails.
3. Sitting down, a person should check the tops of the thighs, the skins, the tops of both feet, between the toes, and under the toenails.
4. While seated, they should use a hand mirror to check the calves, the bottom of the feet, and the backs of the thighs, first on one leg, then the other.
5. They should then check the buttocks, lower back, upper back, genitals, and the back of the neck and ears with the hand mirror. People might find it easier to look at their back in a wall mirror.
6. A person should part their hair with a hair dryer or comb to check their scalp.

People who notice any suspicious changes should speak with a doctor.

Learn about melanoma on darker skin tones.

Medical history

A healthcare professional may ask about suspicious marks on the skin, including questions about:

• when they first appeared
• whether they are itchy, painful, or bleed
• whether they have changed in size or appearance

They may also ask about a person’s family history of skin cancer and their lifestyle, including sun exposure, whether they use tanning beds, and how often they have experienced blistering sunburns.

Learn more about how to tan more safely and minimize the risks.

Physical examination

During a physical examination, a doctor may check for moles and other marks on the body with possible links to skin cancer.

They may also check the lymph nodes in the neck, groin, or underarm regions. This is because melanoma can spread to these locations.

A doctor may refer an individual with suspected melanoma to a dermatologist. This specialist examines lesions more closely using a dermatoscope, which is a small instrument that magnifies the area and provides a light source. They may also take a photo of the affected patch of skin.

Biopsy

A doctor who suspects that a particular area might be a melanoma may request a biopsy to identify the type and how deeply it has penetrated the skin. They choose one of several types based on the location of the melanoma, the size of the mole or lesion, the risk of melanoma having developed, and other factors.

Types of biopsies for melanoma include:

• Shave biopsy: A dermatologist removes the top layers of skin with a blade. They stop the bleeding using an ointment or a small electrical current that closes off the wound. Doctors typically only request this for people with a low risk of melanoma, as it does not show how deep a melanoma has penetrated.
• Punch biopsy: The doctor uses a tool that works in a similar way to a cookie cutter to remove a deeper skin sample. They rotate the tool until it gets through every layer of skin before removing the sample and stitching the area where they removed the skin back together.
• Incisional and excisional biopsy: A dermatologist uses these types of biopsy to examine melanomas that might have moved to deeper layers. In an excisional biopsy, they use a surgical knife to remove the whole tumor and send it to a lab for testing. During incisional biopsies, they only remove part of the tumor.

If a doctor suspects that the melanoma has spread, they may take a lymph node biopsy. A healthcare professional may also order imaging tests, such as a CT scan, to help identify melanomas that have reached the brain, lungs, or other areas.

Learn about cancer that spreads to lymph nodes.

Treatment

Often, treatment for melanoma involves surgery to remove the melanoma as well as an area of unaffected skin around the lesion. However, this depends on the location and type of melanoma.

Removal may be the only treatment necessary for early melanoma. However, a dermatologist may find cancer cells in the skin surrounding the melanoma, meaning it has spread. In this case, they may also need to target and kill cancer cells through other methods, including:

• surgery to remove the lymph nodes
• immunotherapy
• radiation therapy
• targeted therapy
• chemotherapy

Prevention

Regular self-examinations can help prevent melanoma and other types of skin cancer. Other prevention methods involve protection from UV rays, including the following:

• Sheltering in the shade on hot or sunny days.
• Wearing clothes that reduce skin exposure to the sun.
• Using sunscreen on all skin that is not covered by clothing. It should have a sun protection factor (SPF) of 30 or higher.
• Reapplying sunscreen every 2 hours and after sweating or swimming.
• Avoiding tanning beds.
• Taking sun-protection precautions near sand, snow, and water, as these can reflect UV rays.

Summary

By conducting a self-examination, people may be able to identify possible melanomas to discuss with a healthcare professional. Doctors typically use a person’s medical history, a physical examination, and biopsies to diagnose melanoma.

Healthcare professionals may recommend a range of treatments for the condition, including surgery, immunotherapy, and chemotherapy.

People can take steps to help prevent melanoma, such as using sunscreen, avoiding tanning beds, and staying in the shade whenever possible on sunny days.